Blunt injuries to the gallbladder are very uncommon, whereas penetrating gallbladder trauma occurs more frequently. Over the last 19-year period through 1994, 22 cases with blunt gallbladder trauma were treated. Avulsion (partial or complete) and contusion were observed in 10 cases each (45%). Perforation of the gallbladder and traumatic cholecystitis with necrosis were seen in one case each. Associated intra-abdominal trauma was present in 100% of the cases and accounted for both mortalities. Gallbladder injury was diagnosed after celiotomy, except for one case that was diagnosed and treated nonoperatively. Based on the experiences gained herein and an extensive review of the literature, a classification scheme for gallbladder trauma and its treatment is presented.

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Introduction: Laparoscopic cholecystectomy today has been rapidly embraced worldwide as the procedure of choice for cholecystectomy. Conventionally, titanium clips are used to ligate the cystic duct. Recently, various methods of suture ligation of the cystic duct both intra corporeal and extra corporeal have been described during laparoscopic cholecystectomy. Only limited number of studies have been carried out prospectively to compare the various methods. The present study was thus designed to compare clip occlusion versus extra corporeal suture ligation (Roeder knot) of the cystic duct in laparoscopic cholecystectomy. Material and methods: This study was a single blinded randomized controlled trial conducted on 150 adult patients undergoing laparoscopic cholecystectomy. They were randomized into two groups of 75 each to compare the procedures of clip occlusion versus extracorporeal suture ligation (Roeder knot) of the cystic duct with respect to the operative time, complications, associated morbidity, operative cost and hospital stay. Results: There was no significant (p>0.05) difference in duration of surgery between the groups (Clip ligation=40.44±4.63 minutes, suture ligation=43.32±4.44 minutes). Bile leakage due to slippage of ligature was present in 2 (2.7%) patients with clip ligation as compared to 0% in suture ligation. This difference was found to be statistically significant (p=0.03). Obstructive jaundice due to accidental ligation of CBD was present in 2 (2.7%) patients with clip ligation as compared to 0% in suture ligation. This difference was also found to be statistically significant. (p=0.03). The cost of Clip ligation (Rs.369.07±8.08) was higher than suture ligation (Rs.300.00±0.00). Conclusion: The results of this study indicate that extracorporeal (Roeder's knot) is a safe, cost effective alternative with a low complication rate as compared to titanium clip ligation of the cystic duct in laparoscopic cholecystectomy.

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